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Discussing Advance Care Planning with Individuals that have Coronary Artery Disease

Wednesday, December 8, 2021

Coronary Artery Disease (CAD), also known as coronary heart disease, or ischemic heart disease, affects about 18.2 million adults aged 20 and older and about two in 10 deaths from CAD happen in adults less than 65 years old.  CAD narrows or blocks arteries by building up fatty material called plaque, also known as atherosclerosis. Plaque consists of cholesterol, fatty substances, waste products, calcium, and fibrin. Plague can clog or damage your arteries, limiting the blood flow, oxygen, and nutrients the heart needs to function properly. Unfortunately, individuals may not know they have CAD until they experience some type of heart event, such as a heart attack or stroke. 

Why Advance Care Planning?

Any time an individual is diagnosed with a life-changing disease, advance care planning (ACP) should be discussed. CAD provides an especially challenging conversation because an individual can live with the disease for quite some time with the right treatment and diet and exercise plan. However, there is an aspect of CAD that may change the individual’s health standing quickly and that is heart attack or stroke. 

When an individual is diagnosed with CAD, this is a good time to discuss the possibilities of heart attack or stroke and what his or her wishes might be when it comes to their care should either of these things happen. Stroke can leave individuals with difficulty speaking or slurred speech as well as mobility issues that may be a barrier to the individual caring for him/herself. In this case, it is imperative that the medical team know what measures the individual wants the team to take when caring for him/her. 

In both cases, the need for resuscitation may come into play and it is important for caregivers, the medical team, and the family to all be on board with the individual’s wishes as far as the extent he/she may want resuscitation tactics to come into play. 

The Benefits of Advance Care Planning

 A number of cardiac societies and organizations recommend ACP as a part of heart condition care. Most Americans don’t respond well to what the Euros do in healthcare.They suggest it be reviewed annually and more often if disease progression warrants. Benefits of timely initiation of an ACP are as follows

For the individual: 

  • Less time in the hospital
  • Increased peace of mind
  • Comfortable and preferred care location 

For the family: 

  • Increased awareness of loved one’s wishes
  • Early access to palliative care or hospice services
  • Family agreement regarding care preferences

For the healthcare system: 

  • Reduced length of stay
  • Increased hospice use
  • Clarity surrounding care goals
  • Reduced ED and hospital readmission
  • Reduced inappropriate or unwanted care
  • Improved provider satisfaction

For society: 

  • Reduced care costs
  • Open discussions about limitations of care
  • Discussions about quality versus quantity of life

When should Advance Care Planning conversations begin?

The survival rate for adults with CAD has improved recently but remains below the rates for those who are healthy. Individuals and their loved ones benefit from preparation for unexpected and unpredictable health occurrences, sometimes preceded by a prolonged period of declining health. Therefore, ACP is an integral part of comprehensive care planning for these individuals. 

A possible introduction of discussions surrounding ACP should be at diagnosis but if the time doesn’t feel right at that point, it should happen when an individual asks his/her prognosis or treatment plan. These conversations should always be realistic and include comfort measures rather than just strategies to extend life. 

Most individuals have ideas about what they consider the worst aspects of a debilitating or life-altering disease. It is helpful to discuss strategies for preventing these situations to alleviate individual anxieties related to their treatment. Along with these discussions, it is helpful to understand the individual’s emotional, spiritual, and interpersonal needs during the final stages of the disease. 

Partnering with Iris 

Health plans and at-risk provider groups who are interested in providing this beneficial intervention to their members can partner with Iris. We provide an effective way to scale ACP across member populations and provide universal access to Advance Care Planning. 

Our specialized ACP services are designed to support individuals with serious illnesses. We start the planning process early, allowing everyone involved to feel confident about their care choices. Our proprietary, disease-specific AD documentation captures member care goals in straightforward terms, removing complexity for family members during the event of a medical emergency.

To learn more about how Iris can improve your health plan’s ACP services for everyone involved, get in touch with our team today.To learn more about how we can serve your member population with tailored ACP, contact us today.

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